Let's get rid of smallpox for good
A decision to delay, yet again, the destruction of smallpox virus stocks ignores the concerns of the developing world.
Less than 50 years ago, tens of millions of people in many parts of the developing world were still suffering from one of our most feared diseases, smallpox.
The mortality rate was high: between 30 and 40 per cent of those contracting the disease died. And almost all survivors suffered from disfiguring scars that, particularly in the case of women, could virtually eliminate all chances of a normal social life.
Thanks to a concerted campaign launched by the WHO in 1967, which combined widespread vaccination with innovative management strategies, the disease was wiped out within 20 years — the last known naturally occurring case was in Somalia in 1977.
Yet the shine has been taken off this success, one of the WHO's greatest triumphs, by the reluctance of two countries — the United States and Russia — to destroy the last stocks of the smallpox virus they hold.
The two countries are preventing the public health community from claiming that the disease has been successfully eliminated from the face of the Earth — and are keeping alive the fear that it could re-emerge.
This fear is strongest in developing countries, which suffered the most from smallpox (the disease is believed to have originated in Africa before spreading to India and China). They are also, of course, the least well-equipped to face a future outbreak, and their concerns have been put on hold after the go-ahead to destroy stocks has yet again been postponed.
Three year setback
In the face of continued opposition from the United States and Russia, the World Health Assembly, the WHO's governing body, last month deferred for a further three years a decision on whether all existing stocks of the smallpox (Variola) virus types should be destroyed.
The standard argument made by those who favour retention of smallpox stocks is that further research is likely to produce more effective vaccines and treatments.
The unease with currently available interventions stems partly from the history of the original vaccine against the disease, which was later found to be potentially fatal to patients infected with HIV.
The concern appears to be fuelled by fears that if the virus — recently described by one leading Indian virologist as threatening to become "a poor man's atom bomb" — fell into the hands of a terrorist group, it could be used against both military targets and civilian populations.
The first of these arguments, about research, cannot be dismissed. Certainly, more research could be carried out on the virus, particularly into the properties of its many variants. But a recent expert report points out that in the United States, most of this research is primarily required to meet regulations.
And the case for such research is weakened further by the fact that there are now two effective vaccines. Both are widely considered capable of giving people enough protection against any future outbreak of the disease even though, for obvious reasons, testing has had to be restricted to animals.
If, once the current stocks have been destroyed, a situation did arise where new research on the virus was considered essential, enough is now known about its genomic structure to rebuild it from scratch, using the techniques of modern synthetic biology.
Further, many observers believe that the supposed terrorist threat is exaggerated. Despite its potency, the virus spreads slowly and unpredictably, traits that lower its appeal to terrorist groups more drawn to the instant impact (and publicity) of guns, bombs and possibly toxic chemicals.
Finally, there is the economic argument: maintaining the security of existing stocks of Variola, protecting them from either accidental escape or from falling into the wrong hands, is not cheap. And inevitably, it deflects funds and research resources from more pressing problems.
Political factors in play
Why, then, is there continued opposition to the destruction of stocks? Two other factors seem to be at work — both widely acknowledged but neither openly discussed.
One is that in both the United States and Russia scientific careers continue to be built on research into the virus. It is hardly surprising that these researchers do not want the stocks to be destroyed.
A second factor is that, despite the clear shortcomings of smallpox as a useful biological weapon, some fear that both countries are keen to keep stocks of the virus as the source of a future biological weapon.
But both arguments put national interest above the global good. The refusal to agree to the destruction of remaining virus stocks is seen across much of the developing world as an expression by two of the world's superpowers of their continued desire to exercise hegemonic dominance.
Their concerns are given weight by the prospect of developing countries shouldering much of the impact of possible exposure to the virus. According to one Nigerian virologist, an adviser to the WHO, unlike rich countries that have built stockpiles of smallpox vaccine, "Africa is one part of the world where a biological attack with smallpox is likely to have a more devastating effect".
The world deserves, and can do, better. US president Barack Obama, in particular, has indicated his desire to use science as a vehicle of 'soft diplomacy', exercising influence through moral leadership rather than military strength.
A decision to destroy the smallpox virus stocks would be proof of such commitment. The next opportunity to do so will come when the World Health Assembly addresses the issue again in 2014. Obama may well still be in power; if so, the developing world will hope that by then he will have changed his mind.